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General NPI Number Information
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NPI Number | 1528269743
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Entity Type | Individual
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Provider Name | CHRISTIAN FREDERICK FETSCH L.AC., M.S.T.C.M.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 100 W 46TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-4950
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Country | US
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Telephone | 612-871-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 623 ALDINE ST
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City | SAINT PAUL
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State | MN
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Zip | 55104-2271
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Country | US
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Telephone | 612-871-2288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1246
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License Number State | MN
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